Surgical and Biomechanical Perspectives on Osteoarthritis and the ACL Deficient Knee: A Critical Review of the Literature

Abstract

This review was undertaken to better understand the debate regarding the issue of osteoarthritis associated with anterior cruciate ligament (ACL) injuries, from a surgical and biomechanical standpoint. Much of the current debate focuses on contributory surgical factors and their relative roles in increasing or decreasing the risk of future osteoarthritis development, primarily highlighting the controversy over whether reconstructive surgery itself is necessarily protective. This review addresses the evolution of ACL reconstruction techniques over time, and with a view to thoroughly examine the role of surgery, outcome differences in procedural technique are reviewed, with a focus on open versus arthroscopic methods, graft choice and the use of a double versus single bundle reconstruction technique.Moreover, other potentially important contributory factors are identified and discussed, such as intrinsic biomechanical alterations sustained at the time of initial injury, and how these may have a more significant role with regard to future osteoarthritic changes in the knee than previously attributed.

The protective effect of anterior cruciate ligament reconstruction on articular cartilage: a systematic review of animal studies

“…This should be taken into account when observing the effect of animal reconstructive surgery. Arthroscopic procedures are presumed to have less detrimental effect on cartilage compared with extensive open procedures used in animal experiments, which could improve the outcome of ACL reconstruction on the articular cartilage 7 . In animal studies reconstructive ACL arthroscopic procedures are lacking.…”

Progressive Changes in Walking Kinematics and Kinetics After Anterior Cruciate Ligament Injury and Reconstruction: A Review and Meta-Analysis

“…13 Several authors have hypothesized that cartilage-loading patterns or surrogate measures of knee-joint health, such as substantial alterations in 3-dimensional (3D) lower extremity joint angles or peak joint moments, may provide key information about the source of poor short-and longterm outcomes after ACLR. 14,15 Assessing and comparing characteristics of lower extremity movement in those with ACLR may provide a more quantitative approach to identifying patients at elevated risk for reinjury and poor long-term joint health. 14,16 Researchers 14,16,17 have hypothesized about which gait characteristics are important for identifying patients at increased risk of injury or developing knee-joint osteoarthritis after ACLR.…”

Biomechanical Factors Associated With Pain and Symptoms Following Anterior Cruciate Ligament Injury and Reconstruction

“…There is an association between ACL injury and the subsequent development of knee osteoarthritis [7,[30][31][32]. Previous studies have found gait alterations post ACL injury and reconstruction, suggesting that altered kinematics may contribute to the development of knee OA [12][13][14][15]23].…”